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Colorectal Cancer Screening
Once assessment and planning have been completed, including analysis of the collected data, the next step is implementing the strategies and interventions that will comprise the workplace health program. The intervention descriptions on this page include the public health evidence-baseThe development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program planning models. for each intervention, details on designing interventions for colorectal cancer screening, and links to examples and resources.
Multi-component interventions that include communications/media, education, reduction of barriers, and enhanced access to care will increase employees’ awareness of and participation in screening, prevention, and treatment.
Before implementing any interventions, the evaluation plan should also be developed. Potential baseline, process, health outcomes, and organizational change measures for these programs are listed under evaluation of colorectal cancer screening programs.
Of cancers affecting both men and women, colorectal cancer is the second most common cause of cancer deaths in the U.S. population.
- The estimated annual national expenditure for colorectal cancer treatment is $5.5-$6.5 billion; inpatient hospital care accounts for 80% of this cost1
- Because colorectal cancer is a disease of middle and old age, the costs related to colorectal cancer treatment are likely to increase as the population ages1
- In 2007, 142,672 people were diagnosed with colorectal cancer, and 53,219 people died from it2
Risk factors for colorectal cancer include being 50 years of age or older, having a family history of colorectal cancer, having a personal history of inflammatory bowel disease, being overweight or obese, being physically inactive, having certain genetic conditions, and (possibly) consuming inadequate amounts of fruits and vegetables (nutrition).3
The United States Preventive Services Task Force strongly recommends that screening begin at age 50 and continue to age 75, and include:
- colonoscopy (an inspection of the complete colon using a scope inserted into the rectum) every 10 years or
- flexible sigmoidoscopy (inspection of the lower colon using a scope inserted into the rectum) every 5 years or
- high-sensitivity fecal occult blood test (testing feces for digested blood) every 1 year
In Rankings of Preventive Services for the U.S. Population, the Partnership for Prevention provides an approach to ranking preventive services according to their clinically preventable burden (CPB) and cost effectiveness (CE). CPB is the disease, injury and premature death that would be prevented if the service were delivered to all people in the target population. With this approach, colorectal cancer screeningScreening means checking your body for cancer before there are signs or symptoms of the disease. The routine performance of screening tests may find many kinds of cancer early, when treatment is likely to work best. received a ranking of 8 on a scale of 1-10, with 10 the highest ranking.
When colorectal cancer is found early and treated, the 5-year relative survival rate is 90%. Screening can also prevent colorectal cancer by allowing clinicians to identify and remove precancerous polyps before they develop into cancer.
Employee programs refer to activities that include active employee involvement, such as classes, seminars or competitions. Employee programs are frequently provided on-site at the workplace.
Employee health surveys in the workplace provide assessment and implementation opportunities
- Information from employee health surveys can be used not only in obtaining baseline group data on employee health but also to educate individual employees to their needs for screeningScreening means checking your body for cancer before there are signs or symptoms of the disease. The routine performance of screening tests may find many kinds of cancer early, when treatment is likely to work best. and follow-up for specific colorectal cancer concerns
Worksite-wide education campaigns increase use of screening services
- Improving communications about the availability and coverage of preventive services is recommended to increase their use. For example, flyers or brochures about the screenings could be placed in employee break rooms and on bulletin boards. Additional strategies to consider include mailing information and reminders to employees’ homes and company-wide e-mails to employees
- The Task Force on Community Preventive Services reports that use of cancer screening services increases when employees receive consistent communication and reminders about cancer screeningScreening means checking your body for cancer before there are signs or symptoms of the disease. The routine performance of screening tests may find many kinds of cancer early, when treatment is likely to work best.
Tools and Resources (more)
- The local chapter of the American Cancer Society (ACS) may offer educational programs, brochures, and other services. Chapter locations are listed on the ACS website
- The Partnership for Prevention’s Investing in Health: Evidence-Based Health Promotion Practices for the Workplace describes multiple workplace programs to encourage cancer screening, including speaking events, reminders, flyers, and other approaches
- The Centers for Disease Control and Prevention's (CDC) Screen for Life: National Colorectal Cancer Action Campaign includes a number of education materials such as Public Service Announcements (PSA), posters, fact sheets, brochures, and print ads in English and Spanish to raise awareness of colorectal cancer, describe the benefits of colorectal cancer screening, and to motivate individuals to talk to their doctor
Workplace policies promote a corporate “culture of good healthThe creation of a working environment where employee health and safety is valued, supported and promoted through workplace health programs, policies, benefits, and environmental supports. Building a Culture of Health involves all levels of the organization and establishes the workplace health program as a routine part of business operations aligned with overall business goals. The results of this culture change include engaged and empowered employees, an impact on health care costs, and improved worker productivity..”
Providing sick leave or flextime for employee who need screening or clinical follow-up will reduce structural barriers
- Flexible times for beginning and ending work each day, or "flextimeAllow employees to shift their work schedules, such as coming in earlier or later or taking a lunch break at alternate times. Flextime can be useful in creating opportunities for employees to engage in health promotion activities such as physical activity during the day and yet maintain their expected number of work hours. " policies can be useful in creating opportunities for employees to schedule/arrange for a screening during the day yet maintain their expected number of work hours. Flextime policies allow employees to shift their work schedules, such as coming in earlier or later or taking a lunch break at alternate times
Employee health benefits are part of an overall compensation package and affect an employee’s willingness to seek preventive services and clinical care.
Provide coverage for clinical preventive services such as colorectal cancer screening
- Colorectal cancer screening is a valuable early detection tool that can identify colorectal cancer at an early stage, when treatment is more effective and less expensive
- Full coverage of colorectal cancer screening is recommended by the United States Preventive Services Task Force
- Coverage should also include diagnostic follow-up (e.g., biopsies) and treatment
- Benefit packages should include personal reminders to employees regarding their due dates for screening
- Any cancer screeningScreening means checking your body for cancer before there are signs or symptoms of the disease. The routine performance of screening tests may find many kinds of cancer early, when treatment is likely to work best. program must include a plan for following up men and women with a positive reading and referring them to clinical evaluation. It is an ethical standard widely accepted in the medical and public health community that screening programs should always be linked to a follow-up education, referral, and treatment plan
Require health plans to send reminders to both employee members and providers about colorectal cancer screening
- Employee and provider reminders tell people that it is time to schedule a colorectal cancer screening or that they are late (recall) for a recommended screening
- Employee reminders can be mailed as a letter or postcard or communicated as part of a telephone call
- Additional information about the health benefits of the screening, strategies to overcome barriers to screening and assistance with scheduling a screening test can also be included as part of the reminder
Tools and Resources (more)
- National Business Group on Health’s A Purchaser’s Guide to Clinical Preventive Services: Moving Science into Coverage provides benefits package language for clinical colorectal cancer screening
Environmental support provides a worksite physically designed to encourage good health.
Reducing structural barriers increases rates of colorectal cancer screening by Fecal Occult Blood Test (FOBT)
- The Task Force on Community Preventive Services has found that reducing structural barriers to care increases rates of colorectal cancer screening by FOBT. Structural barriers include problems such as clinic location, distance to clinic, hours of operation, appointment scheduling, language barriers, or work schedule
- Interventions to reduce structural barriers are based on the idea that making access to screening easier will increase use of screening. Examples include interventions that:
- Reduce time or distance to delivery setting
- Modify hours of service to meet client needs
- Offer services in alternative, nonclinical settings
- Eliminate or simplify administrative procedures (e.g., scheduling help, transportation, translation)
- Provide secondary support, such as education
Tools and Resources
- In addition to the following suggestions for health-related programs, policies, health benefits, and environmental support for colorectal cancer screening programs, see recommendations for obesity, physical activity, and nutrition that relate to colorectal colorectal risk
- The American Cancer Society’s Workplace Solutions (http://www.acsworkplacesolutions.com/) has a number of cancer programs
- The National Business Group on Health (NBGH) has developed Pathways to Managing Cancer in the Workplace which describes the economic impact of cancer to employers and discusses prevention and early detection strategies and workplace supports and services for breast, colorectal, lung, and prostate cancers.
- Why Invest? Recommendations for Improving Your Prevention Investment is a report developed by the Partnership for Prevention with support from CDC that includes examples from organizations investing in preventive services for their employees and recommendations to employers for increasing the coverage and use of preventive services